How far will Democrats go to pass health reform?

They're talking about using the budget reconciliation process for some parts, but it could be risky. Part 2 of two.

Alex Brandon/AP

President Barack Obama listens to a question during the Organizing for America National Health Care Forum at the Democratic National Committee headquarters in Washington on Aug. 20. The last congressional panel working on healthcare legislation – the Senate Finance Committee – seems ready to give up on its bipartisan efforts.

It’s called “reconciliation,” and yes, it’s Washington jargon. But anyone who wants to understand where healthcare reform might be heading when Congress resumes next week needs to pay attention to that word.

The last congressional panel working on healthcare legislation – the Senate Finance Committee – seems ready to give up on its bipartisan efforts. Two of the committee’s three Republicans working as part of the so-called Gang of Six have made disparaging comments lately about the outlines of reform, leading many Democrats to assume that the effort is effectively over.

But there’s virtually no chance that the more-liberal reform plans can make it through the Senate under normal rules, which require 60 votes to halt a legislation-killing filibuster. So Democrats are increasingly talking about going it alone and using the budget reconciliation process to pass at least parts of the reform.

The crucial difference is that passage under reconciliation requires a simple majority vote. One key health reform the Democrats might try to pass via reconciliation is creation of a “public option,” a government-run insurance program designed to compete with private insurers and bring down costs.

“If we are unable to [pass legislation] any other way, that is an option,” he said.

Reconciliation is a 35-year-old procedure used in congressional budgeting. To qualify, a bill must have a demonstrable impact on the federal budget, either by saving money or costing money over the life of the budget (currently, five years). Democrats believe the plan for a public insurance option would satisfy that criterion.

Republicans call the possible use of reconciliation on major parts of healthcare reform an abuse of the legislative process. But the record shows that the technique has been used for legislation that had policy purposes broader than changing spending or revenues.

One example is the 1996 welfare reform, passed by the GOP-controlled Congress and signed by President Clinton.

Still, going the reconciliation route for the most controversial parts of health reform is risky.

And it’s not even certain that the Senate parliamentarian would allow the public option to be considered under reconciliation. It’s also not certain that the Democrats could garner a simple majority, given the controversy that reconciliation would spark. Some conservative Democrats are worried about reelection or might object on principle.

Another downside for Democrats is that because Congress opted for a five-year budget, any pieces of health reform implemented under reconciliation would sunset after five years.

When the Republicans inevitably have a majority in Congress again, they may not hesitate to use reconciliation on major legislation.

But Democrats are under pressure to act by year’s end, as the 2010 election cycle heats up. And as President Obama’s popularity declines, chances are the Democrats will have smaller majorities after 2010.

For now, though, what can Republicans do? Pound away on public opinion. The less popular Democrats’ version of health reform, the less likely fence-sitters in the Senate will be willing to vote for it.

But all Democrats need is 50 senators. Vice President Joe Biden, as president of the Senate, can come in and break a tie.